DEAR DR. GOTT: I’ve been seeing an optometrist for several years now, and even though he says I don’t need a new prescription and he has diagnosed me with the beginning of cataracts, I don’t feel I can see as well as I once did. So I made an appointment yesterday with my ophthalmologist, who told me I have bilateral cataracts that have advanced to the point of requiring surgical removal.
Now comes the hard part. My ophthalmologist indicates my risk of retinal detachment will increase. Can this be repaired if it happens? Perhaps I should suffer with poor vision rather than take the chance.
DEAR READER: Cataracts develop slowly, so we have a tendency to attribute diminished vision to the aging process. They cloud vision, much like looking through a dirty or foggy window. We may see halos around lights, have difficulties reading or driving at night, colors fade and diplopia (double vision) may be present in one eye only.
A cataract may affect a small portion of the lens of the eye but will eventually grow, distorting the light that passes through it. We may compensate by being prescribed stronger eyeglasses and turning on more lights when reading; however, there comes a time when vision will be impaired enough in one or both eyes to require surgical repair.
Cataracts may be congenital (present from birth) or can develop as we age. They affect the center, edges or back of the lens. Each location presents with its own characteristics. Those that affect the center may cause double images. The lens may yellow or eventually turn brown. It’s this modification of the lens that causes difficulties distinguishing colors. Those that affect the edges interfere with light passing through the center of the lens. Night driving becomes difficult because of the glare of oncoming vehicles. When a cataract obstructs the back of the lens, difficulties reading and halos can result. Congenital cataracts don’t always affect vision but when they do, surgical repair is commonly performed as soon as they are detected.
There are several conditions that may contribute to developing cataracts. Extensive sunlight exposure without the use of sunglasses blocking harmful ultraviolet rays, hypertension, obesity, diabetes, advancing age, smoking and consuming excessive amounts of alcohol are but a few of the known causes.
If your ophthalmologist has recommended surgical repair, it is likely because of the advancement of your cataracts and the effect they have had on your quality of life. Furthermore, the benefits of the procedure(s) must outweigh the risks. There comes a time when a stronger prescription will no longer be sufficient, but this doesn’t imply you should rush into surgery. That decision can best be left to you and your doctor. You have time to make a sensible decision. Your cataracts will not advance to a point where they cannot be removed.
Surgery involves removing the clouded lenses and replacing them with a plastic implant. There is generally a period of three or four weeks between the procedures. Local anesthesia numbs the area around the eye(s), but you will be awake and alert during the procedure. And, as you have been told, repair does increase the risk of retinal detachment, a condition that develops when the retina at the back of the eye pulls away from the blood vessels that supply oxygen and nutrients. This occurs in less than 1 percent of cases. Advanced diabetes, trauma or shrinkage of the vitreous fluid that fills the inside of the eye, prior eye surgery and myopia (extreme nearsightedness) may be to blame.
Warning signs of retinal detachment include numerous floaters, light flashes and a shadow over the visual field. Should these or other unusual symptoms occur, you should seek immediate medical attention either with your eye doctor or an emergency department.
Treatment options include several rather sophisticated but successful procedures. A loss of vision to the portion of the eye that corresponds to the detachment will result unless surgery is performed.
I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.